J Korean Med Sci.  2016 Jun;31(6):932-938. 10.3346/jkms.2016.31.6.932.

Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy

• Lee S
• Yeo HJ
• Yoon SH
• Lee SE
• Cho WH
• Jeon DS
• Kim YS
• Son BS
• Kim DH

• KMID: 2373703
• DOI: http://doi.org/10.3346/jkms.2016.31.6.932

Abstract

Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

Keyword

Extracorporeal Membrane Oxygenation; Respiratory Distress Syndrome; Adult; Intensive Care; Outcome Assessment

MeSH Terms

Adult
Aged
Area Under Curve
*Extracorporeal Membrane Oxygenation/classification
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
ROC Curve
Republic of Korea
Research Design/*standards
Respiratory Distress Syndrome, Adult/mortality/pathology/*therapy
Retrospective Studies
Severity of Illness Index

Figure

• 

  Fig. 1 Comparison of the receiver-operating curves for all risk prediction tools (n = 50). The ROC curve reveals that PRESERVE score significantly discriminated survivors and non-survivors with an AUC of 0.80. RESP score and SAPS II score expose fair discrimination with an AUC of 0.79 and 0.78, respectively. The score proposed by Roch et al. (5) also had fair prediction ability, however, ECMOnet score failed to discriminate with AUC of 0.518. AUC, area under the curve; ROC, receiver operating curve; CI, confidence interval; PRESERVE, predicting death for severe ARDS on VV-ECMO; SAPS, simplified acute physiology score; RESP, respiratory extracorporeal membrane oxygenation survival prediction.

• 

  Fig. 2 Kaplan-Meier analysis for hospital survival probability according to cut-off point. (A) The patient group in RESP score above the cut-off point of -1 was indicated significantly higher hospital survival rate that the patient group those who were below the cut-off point of -1 (P = 0.001). (B) The lower Pre-ECMO SAPS II score group (≤ 58 points) showed a significantly higher hospital survival than the higher Pre-ECMO SAPS II score group (> 58 points) in the study population (P = 0.005). RESP, respiratory extracorporeal membrane oxygenation survival prediction; SAPS, simplified acute physiology score.

Reference

1. Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013; 187:276–285.

2. Schmidt M, Zogheib E, Rozé H, Repesse X, Lebreton G, Luyt CE, Trouillet JL, Bréchot N, Nieszkowska A, Dupont H, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med. 2013; 39:1704–1713.

3. Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, Ranieri VM, Gattinoni L, Landoni G, Holzgraefe B, et al. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score. Intensive Care Med. 2013; 39:275–281.

4. Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, Cooper DJ, Brodie D, Pellegrino V, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014; 189:1374–1382.

5. Roch A, Hraiech S, Masson E, Grisoli D, Forel JM, Boucekine M, Morera P, Guervilly C, Adda M, Dizier S, et al. Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center. Intensive Care Med. 2014; 40:74–83.

6. Enger T, Philipp A, Videm V, Lubnow M, Wahba A, Fischer M, Schmid C, Bein T, Müller T. Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care. 2014; 18:R67.

7. Extracorporeal Life Support Organization (US). ELSO guidelines for adult respiratory failure v1.3 (ELSO adult respiratory failure supplement to the ELSO general guidelines) [Internet]. accessed on 1 May 2015. Available at http://www.elso.org/Resources/Guidelines.aspx.

8. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342:1301–1308.

9. Extracorporeal Life Support Organization (US). ELSO guidelines general v1.3 (general guidelines for all ECLS cases) [Internet]. accessed on 1 May 2015. Available at http://www.elso.org/Resources/Guidelines.aspx.

10. Kohler K, Valchanov K, Nias G, Vuylsteke A. ECMO cannula review. Perfusion. 2013; 28:114–124.

11. Alhazzani W, Alshahrani M, Jaeschke R, Forel JM, Papazian L, Sevransky J, Meade MO. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2013; 17:R43.

12. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009; 374:1351–1363.

13. Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med. 2009; 35:2105–2114.

14. Klinzing S, Wenger U, Steiger P, Starck CT, Wilhelm M, Schuepbach RA, Maggiorini M. External validation of scores proposed for estimation of survival probability of patients with severe adult respiratory distress syndrome undergoing extracorporeal membrane oxygenation therapy: a retrospective study. Crit Care. 2015; 19:142.

15. Le Gall JR, Loirat P, Alperovitch A. Simplified acute physiological score for intensive care patients. Lancet. 1983; 2:741.